Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics

Study DesignThe study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF).PurposeTo clarify the evaluation of true diagnosis and to plane the surgical treatment.Overview of LiteratureMNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations.MethodsPatients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system.ResultsThere were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery.ConclusionsThe spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system

Eczane İçi Etkileşimlerin Konuşma Çözümlemesi Yoluyla İncelenmesi: Uzmanlık Bilgisi Gösterimi

Pharmaceutical care is defined as practitioner responsibility that optimizes the patient to use drug treatment as effectively and safely as possible under all circumstances. The importance of communication skills for pharmacists having responsibilities in pharmaceutical care has been demonstrated through studies. Studies have shown that the use of good communication skills can improve patient health outcomes. Communication between pharmacist and patient is crucial not only to achieve the desired satisfaction in the patient, but also to improve the outcome of the medication and treatment. Effective, motivating and purposeful communication is one of the most important tools in drug counseling. Communication is a necessary tool for providing effective and advanced medication. Although there are a relatively large number of quantitative studies used to examine pharmacists' communications, there has been little qualitative study to examine the quality of pharmacy interactions. In this thesis study, it is aimed to investigate the interactions in the pharmacy and to determine the dynamics of the interaction in this way. 21 extracts of the 300 extracts were included in this thesis. After detailed transcriptions, the " displaying of pharmacist's expertness knowledge" interaction pattern has been identified. The pharmacist, customer and pharmacy staff-inducted extracts were investigated in three groups to display expert knowledge. It was determined that the pharmacist demonstrated his expertise by expansions and repairs, offering alternatives and account. In order to develop the interactional competencies of pharmacists, it is thought that these analyses should be increased and these should be entegrated in pharmacy education.Farmasötik bakım, hastanın ilaç tedavisini her koşulda mümkün olduğunca etkili ve güvenli bir şekilde kullanmalarını optimize eden uygulayıcı sorumluluğu olarak tanımlanmıştır. Farmasötik bakım konusunda sorumlulukları olan eczacılar için de iletişim becerilerinin önemi, yapılan çalışmalarla ortaya konmuştur. Araştırmalar, iyi iletişim becerilerinin kullanımının hasta sağlığı sonuçlarını iyileştirebileceğini göstermiştir. Eczacıların iletişimlerini incelemek için, anketlerin kullanıldığı nispeten çok sayıda niceliksel çalışma bulunsa da, eczane etkileşimlerinin niteliğini inceleyen çok az nitel çalışma yapılmıştır. Bu tez çalışmasında, eczane içi etkileşimlerin KÇ yoluyla incelenmesi ve bu şekilde etkileşimin dinamiklerinin saptanması amaçlanmıştır. 300 tane kesidin yer aldığı verinin 21 kesidine tezde yer verilmiştir. Detaylı transkripsiyonlar sonrasında, “eczacının uzmanlık bilgisini gösterme” etkileşim deseni saptanmıştır. Eczacı, müşteri ve eczane personeli başlatımlı uzmanlık bilgisi gösterimi kesitleri olmak üzere üç grupta incelenmiştir. Eczacının genişletmeler ve onarım yaparak, alternatif sunarak ve açıklamalarda bulunarak uzmanlık bilgisini gösterdiği saptanmıştır. Eczacıların etkileşimsel yetilerini geliştirmesi için, bu çözümlemelerin artırılması ve eczacılık eğitiminde bunlara yer verilmesi gerektiği düşünülmektedir